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Meta-analysis of interrupted versus continuous suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy

Authors:
  • Health Education West Midlands
  • NHS Wales Health Education and Improvement Wales
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Aims To compare outcomes of interrupted (IS) and continuous (CS) suturing techniques for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy. Methods The study protocol was prospectively registered in PROSPERO (registration number: CRD42021286294). A systematic search of MEDLINE, CENTRAL, and Web of Science and bibliographic reference lists were conducted (last search: 14th March 2022). All comparative studies reporting outcomes of IS and CS in hepaticojejunostomy and choledochocholedochostomy were included and their risk of bias was assessed using ROBINS-I tool. Overall biliary complications, bile leak, biliary stricture, cholangitis, liver abscess, and anastomosis time were the evaluated outcome parameters. Results Ten comparative studies (2 prospective and 8 retrospective) were included which reported 1617 patients of whom 1186 patients underwent Roux-en-Y hepaticojejunostomy (IS: 789, CS: 397) and the remaining 431 patients underwent duct-to-duct choledochocholedochostomy (IS: 168, CS: 263). Although use of IS for hepaticojejunostomy was associated with significantly longer anastomosis time (MD: 14.15 min, p=0.0002) compared to CS, there was no significant difference in overall biliary complications (OR: 1.34, p=0.11), bile leak (OR: 1.64, p=0.14), biliary stricture (OR: 0.84, p=0.65), cholangitis (OR: 1.54, p=0.35), or liver abscess (OR: 0.58, p=0.40) between two groups. Similarly, use of IS for choledochocholedochostomy was associated with no significant difference in risk of overall biliary complications (OR: 0.92, p=0.90), bile leak (OR: 1.70, p=0.28), or biliary stricture (OR: 1.07, p=0.92) compared to CS. Conclusions Interrupted and continuous suturing techniques for Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedochostomy seem to have comparable clinical outcomes. The available evidence may be subject to confounding by indication with respect to diameter of bile duct. Future high-quality research is encouraged to report the outcomes with respect to duct diameter and suture material.
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https://doi.org/10.1007/s00423-022-02548-y
SYSTEMATIC REVIEWS ANDMETA-ANALYSES
Meta‑analysis ofinterrupted versuscontinuous suturing forRoux‑en‑Y
hepaticojejunostomy andduct‑to‑duct choledochocholedochostomy
ShahinHajibandeh1 · ShahabHajibandeh2· AlessandroParente1· DavidBartlett1· NikolaosChatzizacharias1·
BobbyV.M.Dasari1· HermienHartog1· M.ThamaraP.R.Perera1· RaviMarudanayagam1· RobertP.Sutclie1·
KeithJ.Roberts1· JohnR.Isaac1· DariusF.Mirza1
Received: 7 January 2022 / Accepted: 8 May 2022
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022
Abstract
Aims To compare outcomes of interrupted (IS) and continuous (CS) suturing techniques for Roux-en-Y hepaticojejunostomy
and duct-to-duct choledochocholedochostomy.
Methods The study protocol was prospectively registered in PROSPERO (registration number: CRD42021286294). A
systematic search of MEDLINE, CENTRAL, and Web of Science and bibliographic reference lists were conducted (last
search: 14th March 2022). All comparative studies reporting outcomes of IS and CS in hepaticojejunostomy and choledo-
chocholedochostomy were included and their risk of bias was assessed using ROBINS-I tool. Overall biliary complications,
bile leak, biliary stricture, cholangitis, liver abscess, and anastomosis time were the evaluated outcome parameters.
Results Ten comparative studies (2 prospective and 8 retrospective) were included which reported 1617 patients of whom
1186 patients underwent Roux-en-Y hepaticojejunostomy (IS: 789, CS: 397) and the remaining 431 patients underwent
duct-to-duct choledochocholedochostomy (IS: 168, CS: 263). Although use of IS for hepaticojejunostomy was associated
with significantly longer anastomosis time (MD: 14.15 min, p=0.0002) compared to CS, there was no significant difference
in overall biliary complications (OR: 1.34, p=0.11), bile leak (OR: 1.64, p=0.14), biliary stricture (OR: 0.84, p=0.65),
cholangitis (OR: 1.54, p=0.35), or liver abscess (OR: 0.58, p=0.40) between two groups. Similarly, use of IS for choledocho-
choledochostomy was associated with no significant difference in risk of overall biliary complications (OR: 0.92, p=0.90),
bile leak (OR: 1.70, p=0.28), or biliary stricture (OR: 1.07, p=0.92) compared to CS.
Conclusions Interrupted and continuous suturing techniques for Roux-en-Y hepaticojejunostomy or duct-to-duct choledo-
chocholedochostomy seem to have comparable clinical outcomes. The available evidence may be subject to confounding
by indication with respect to diameter of bile duct. Future high-quality research is encouraged to report the outcomes with
respect to duct diameter and suture material.
Keywords Continuous suture· Interrupted suture· Hepaticojejunostomy· Holedochocholedochostomy
Introduction
Biliary reconstruction is a necessary step in several surgi-
cal procedures, including liver transplantation, pancreatic
resections, liver resections, and bile duct resections due to
malignancies, congenital anomalies, benign biliary stric-
tures, or intraoperative injury [13].
Roux-en-Y hepaticojejunostomy is a well-established
biliary reconstruction approach in all aforementioned clini-
cal situations [46]. Formation of a bilioenteric anastomo-
sis using the Roux-en-Y jejunum limb can facilitate a safe
and permissive anastomosis even when it involves small
intrahepatic branches [7]. Duct-to-duct choledochochole-
dochostomy is another well-established method of biliary
reconstruction which is mainly performed in deceased liver
transplantation and has been increasingly performed in right
lobe living donor liver transplantation (LDLT) [8].
* Shahin Hajibandeh
shahin_hajibandeh@yahoo.com
1 Hepatobiliary andPancreatic Surgery andLiver Transplant
Unit, Queen Elizabeth Hospital Birmingham, Birmingham,
UK
2 Department ofHepatobiliary andPancreatic Surgery,
University Hospital ofWales, Cardiff, UK
/ Published online: 13 May 2022
Langenbeck's Archives of Surgery (2022) 407:1817–1829
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